Anhydroexfoliamycin, a secondary metabolite from Streptomyces, has shown antioxidant properties in primary cortical neurons reducing neurodegenerative hallmarks diseases, both in vitro and in vivo models. Activated microglia, in the central nervous system, plays a crucial role in neuroinflammation and is associated with neurodegeneration. Therefore, the aim of the present study was to determine the anti-inflammatory and antioxidant potential of the anhydroexfoliamycin over microglia BV2 cells. Neuroinflammation was simulated by incubation of microglia cells in the presence of lipopolysaccharide to activate proinflammatory transduction pathways. Moreover, a coculture of neuron SH-SY5Y and microglia BV2 cells was used to evaluate the neuroprotective properties of the Streptomyces metabolite. When microglia cells were preincubated with anhydroexfoliamycin, proinflammatory pathways, such as the translocation of the nuclear factor κB, the phosphorylation of c-Jun N-terminal kinase, and the inducible nitric oxide synthase expression, were inhibited. In addition, intracellular reactive oxygen species generation and the liberation of nitric oxide, interleukin 6, and tumor necrosis factor α were also decreased. Besides, the Streptomyces-derived compound showed antioxidant properties promoting the translocation of the factor erythroid 2-related factor 2 and protecting the SH-SY5Y cells from the neurotoxic mediators released by activated microglia. The effects of this compound were at the same level as the immunosuppressive drug cyclosporine A. Therefore, these results indicate that anhydroexfoliamycin is a promising tool to control microglia-driven inflammation with therapeutic potential in neuroinflammation.
Anhydroexfoliamycin, a secondary metabolite from Streptomyces, has shown antioxidant properties in primary cortical neurons reducing neurodegenerative hallmarks diseases, both in vitro and in vivo models. Activated microglia, in the central nervous system, plays a crucial role in neuroinflammation and is associated with neurodegeneration. Therefore, the aim of the present study was to determine the anti-inflammatory and antioxidant potential of the anhydroexfoliamycin over microglia BV2 cells. Neuroinflammation was simulated by incubation of microglia cells in the presence of lipopolysaccharide to activate proinflammatory transduction pathways. Moreover, a coculture of neuron SH-SY5Y and microglia BV2 cells was used to evaluate the neuroprotective properties of the Streptomyces metabolite. When microglia cells were preincubated with anhydroexfoliamycin, proinflammatory pathways, such as the translocation of the nuclear factor κB, the phosphorylation of c-Jun N-terminal kinase, and the inducible nitric oxide synthase expression, were inhibited. In addition, intracellular reactive oxygen species generation and the liberation of nitric oxide, interleukin 6, and tumor necrosis factor α were also decreased. Besides, the Streptomyces-derived compound showed antioxidant properties promoting the translocation of the factor erythroid 2-related factor 2 and protecting the SH-SY5Y cells from the neurotoxic mediators released by activated microglia. The effects of this compound were at the same level as the immunosuppressive drug cyclosporine A. Therefore, these results indicate that anhydroexfoliamycin is a promising tool to control microglia-driven inflammation with therapeutic potential in neuroinflammation.
Microglia, a macrophage-like
population, is crucial in the central
nervous system (CNS) as host defense, neuronal homeostasis, and tissue
repair.[1] In a healthy brain, resident microglia
are mainly responsible for innate immunity and become activated in
response to stressful stimuli such as injury, damaged cells, and infections.[2] Depending on the stimulus that causes microglia
activation, microglia can adopt polarized phenotypes, ranging from
proinflammatory M1 phenotype (classical activation) to M2 immunosuppressive
phenotype (alternative activation/acquired deactivation).[3] Proinflammatory microglia activation is associated
with proinflammatory cytokines release, such as proinflammatory interleukins
(IL) and tumor necrosis factor α (TNF-α), as well as with
the production of nitric oxide (NO) and reactive oxygen species (ROS)
increase.[4] Initially, this activation represents
the first line of defense in the brain, where microglia are the main
component of neuroinflammation in the CNS. Nevertheless, when neuroinflammation
becomes chronic, activated microglia are detrimental to neuronal cells,
participating in the progression of several neurodegenerative disorders,
namely, Alzheimer’s disease, Parkinson’s disease, and
amyotrophic lateral sclerosis.[3,5,6] Meanwhile, the M2 phenotype is characterized by its neuroprotective
functions that are associated with increased IL-4, neurotrophic factors,
and proteases release, among others. Furthermore, M2 microglia activity
leads to the removal of tissue debris as well as to the reduction
of inflammation without causing neuronal cells’ dysfunction
and death.[7,8] Therefore, in neuroinflammation-mediated
neurodegenerative disease, changing the M1 phenotype to the beneficial
M2 by drug treatment would be an interesting therapeutic target.Several factors can participate in the microglia activation, such
as environmental factors, age, peptides or proteins (observed in neurodegenerative
disorders, like Alzheimer’s disease or Parkinson’s disease),
and accumulation of toxic metabolites, contributing to the neuroinflammatory
pathway.[9] Microglia express some immune
receptors, including toll-like receptors (TLRs). The presence of proinflammatory
stimuli increases the expression of TLRs that are responsible for
pathogen-associated molecular pattern recognition.[10] TLRs are a type I transmembrane protein responsible for
immune response; nevertheless, an improper TLR response leads to acute
and chronic inflammation.[11] Lipopolysaccharide
(LPS), an endotoxin of the outer membrane of the Gram-negative bacteria,
through TLR4 signaling induces an inflammatory response in the microglia.
The binding of LPS to TLR4 results in the activation of several transduction
pathways, such as transcription factor nuclear factor (NF) κB
and mitogen-activated kinases (MAPK), which enhance the production
of proinflammatory cytokines and inducible nitric oxide synthase (iNOS),
among others, resulting in neuroinflammation.[10,11] Hence, inhibiting NF-κB or MAPK pathway activation is gaining
relevance as a therapeutic approach to alleviate the progression of
neuroinflammation.Streptomyces, a Gram-positive
filamentous bacteria
group, is the largest and most studied genus of Actinobacteria.[12]Streptomyces species
are prolific producers of a significant number of metabolites with
diverse properties.[13] Moreover, this genus
is the source of several clinical compounds with immunosuppressive,
antitumor, anthelmintic, antifungal, and antibiotic activities, among
others.[14−16] Furthermore, some Streptomyces secondary
metabolites have shown neuroprotection against neurodegenerative disorders.[17,18] Anhydroexfoliamycin (AE), a Streptomyces secondary
metabolite, has shown antioxidant properties in primary cortical neurons
through the improvement of mitochondrial dysfunction, reduction of
ROS generation, and enhancement of antioxidant enzymes (Figure ).[19] Moreover, this metabolite reduced hallmarks of Alzheimer’s
disease, such as Aβ and tau proteins, in in vitro and in vivo models.[20] Considering that neuroinflammation can be triggered by oxidative
stress and is widely associated with the pathogenesis of Alzheimer’s
disease, the potential protective effects of AE were tested against
the inflammation LPS-induced in microglia cells.
Figure 1
Structure of anhydroexfoliamycin.
Structure of anhydroexfoliamycin.
Results and Discussion
The present study describes the effects of the Streptomyces secondary metabolite, AE, over an in vitro inflammatory
model. In this cellular model, LPS was used to activate microglia
BV2 cells, re-creating neuroinflammatory conditions. In consequence,
NF-κB and JNK MAPK pathways were activated, and the release
of proinflammatory cytokines, including IL-6 and TNF-α, as well
as the production of NO and ROS, was increased. Moreover, this is
a suitable cell model of microglia inflammation since 90% of the genes
induced by LPS in BV2 microglia cells are also induced in primary
microglia.[21]Streptomyces, from the genus Actinobacteria, has contributed
to the development of two-thirds of the currently
used antibiotics and so secondary metabolites of great interest. Moreover,
natural products may serve as the basis to supply lead compounds with
therapeutic potential in pathologies with an inflammatory origin.
Numerous natural products have been widely used in the treatment of
inflammatory-related diseases in clinical settings, including triptolide,
resveratrol, and silymarin.[22,23]Streptomyces secondary metabolites, from species in soil and marine ecosystems,
are also a rich source of new compounds for drug discovery.[24] The hyperarid Atacama Desert (Chile) is one
source of secondary metabolites from Streptomyces sp., including the AE used in the present study.[25,26] AE has shown interesting antioxidant properties. We have tested
the Streptomyces derivative on primary cortical neurons
and showed neuroprotection against H2O2 damage,
maintaining the mitochondrial membrane potential, reducing ROS, and
enhancing antioxidant enzyme levels through nuclear factor erythroid
2-related factor 2 (Nrf2) translocation to the nucleus.[19] Moreover, in an in vitro model
of Alzheimer’s disease, some kinases, including JNK, that control
tau phosphorylation and Aβ42 levels were reduced by AE.[20] In addition, we have also tested AE in 3xTg-AD
mice, a transgenic model of AD that also develops neuroinflammation.[27] In these in vivo experiments,
the AE protects against AD pathology since it was able to ameliorate
major hallmarks of AD through kinases modulation and reducing of Aβ
and tau proteins.[20] The promising results
of this metabolite in neurodegenerative disorders led us to check
its effect over activated microglia. Since several intracellular processes
and cells are altered in neuroinflammation-related diseases, compounds
able to target major hallmarks of the disease and to reduce neuroinflammation
would be welcome.[28] Also, this compound
has never been tested in inflammatory models.For this purpose,
AE was tested in an inflammatory cellular model
to evaluate its effects over inflammation since microglia-mediated
neuroinflammation is implicated in the development of neurodegenerative
diseases.[3] Therefore, microglia BV2 cells
were used, as they are frequently employed to test compounds for anti-inflammatory
properties. Furthermore, LPS stimulates the activation and therefore
the inflammatory response of microglia.[29,30] First, the
effect of AE over cell viability was assessed to determine if AE would
affect microglial cells. As Figure a shows, no cytotoxic effects were found by the Streptomyces derivative at any concentration tested (0.001–10
μM). From previous work, 500 ng/mL of LPS was used to activate
BV2 cells, since this concentration does not modify cell viability
but can stimulate inflammatory conditions.[31] Then, the effect of AE (0.001–10 μM) over cell viability
in the presence of 500 ng/mL of LPS was also determined. As Figure b shows, after 24
h of incubation with AE and LPS, no modifications over cell survival
were found. Therefore, since the concentrations tested did not show
cytotoxicity, for neuroinflammation experiments, the most effective
concentration of AE (0.1 μM) in previous experiments was chosen.[19,20]
Figure 2
Effect
of AE on cell viability in microglia BV2 cells. Cells were
treated with AE at different concentrations (0.001, 0.01, 0.1, 1,
and 10 μM) for 24 h (a) or with different AE concentrations
(0.001, 0.01, 0.1, 1, and 10 μM) plus LPS (500 ng/mL) (b). Cell
viability was measured by MTT assay. Data are represented as a percentage,
being the result of mean absorbance ± SEM of a minimum of N = 3 independent experiments performed in triplicate. The
values are shown as the difference between control cells versus cells
treated by ANOVA statistical analysis followed by post hoc Dunnet’s t-test. AE: anhydroexfoliamycin. LPS: lipopolysaccharide.
Effect
of AE on cell viability in microglia BV2 cells. Cells were
treated with AE at different concentrations (0.001, 0.01, 0.1, 1,
and 10 μM) for 24 h (a) or with different AE concentrations
(0.001, 0.01, 0.1, 1, and 10 μM) plus LPS (500 ng/mL) (b). Cell
viability was measured by MTT assay. Data are represented as a percentage,
being the result of mean absorbance ± SEM of a minimum of N = 3 independent experiments performed in triplicate. The
values are shown as the difference between control cells versus cells
treated by ANOVA statistical analysis followed by post hoc Dunnet’s t-test. AE: anhydroexfoliamycin. LPS: lipopolysaccharide.Inflammation and microglia activation promote oxidative
stress
and DNA damage leading to ROS overproduction. In addition to ROS causing
direct cytotoxicity, it also triggers the activation of proinflammatory
pathways. Mitochondria are the main source of ROS, and the excessive
production of ROS by the electron transport chain or impairment of
antioxidant defense causes mitochondrial dysfunction and the initiation
of cell death and neurodegeneration.[32] Therefore,
the effect of AE over ROS in BV2 cells activated by LPS was measured.
Cyclosporine A (CsA) was used as a control of anti-inflammatory effects
since it is a well-known anti-inflammatory and immunosuppressive drug.[31] As Figure shows, when cells were treated with LPS, the ROS production
was 40% increased (p < 0.01) compared with untreated
cells. When BV2 was pretreated 1 h with AE before the LPS stimulation,
ROS levels were decreased in a dose-dependent fashion. In this sense,
the pretreatment with AE reduced the ROS production stimulated by
LPS at the same level as CsA control (p < 0.01).
Both compounds restored ROS levels up to control values. Furthermore,
several studies have described that the LPS-induced inflammatory response
in microglia is directly associated with ROS overproduction and, by
direct reduction of ROS release, the inflammatory response is inhibited.[33,34] Therefore, the inhibition of ROS generation by the Streptomyces secondary metabolite may lead to inflammatory response reduction.
Figure 3
Effect
of AE on intracellular ROS production in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE at 0.1 μM
for 1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA
was used as a control of anti-inflammatory effects (1 μM). ROS
levels were measured with DCFH-DA. Data are represented as a percentage,
being the result of mean fluorescence intensity ± SEM of a minimum
of N = 3 independent experiments performed in triplicate.
The values are shown as the difference between cells treated with
LPS alone versus cells treated with compounds in the presence of LPS
by ANOVA statistical analysis followed by post hoc Dunnet’s t-test: **p < 0.01, or cells treated
with LPS versus control cells; ##p <
0.01. AE: anhydroexfoliamycin. CsA: cyclosporine A. LPS: lipopolysaccharide.
Effect
of AE on intracellular ROS production in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE at 0.1 μM
for 1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA
was used as a control of anti-inflammatory effects (1 μM). ROS
levels were measured with DCFH-DA. Data are represented as a percentage,
being the result of mean fluorescence intensity ± SEM of a minimum
of N = 3 independent experiments performed in triplicate.
The values are shown as the difference between cells treated with
LPS alone versus cells treated with compounds in the presence of LPS
by ANOVA statistical analysis followed by post hoc Dunnet’s t-test: **p < 0.01, or cells treated
with LPS versus control cells; ##p <
0.01. AE: anhydroexfoliamycin. CsA: cyclosporine A. LPS: lipopolysaccharide.In the CNS, NO acts as a neurotransmitter and cellular
messenger.
Nevertheless, under pathological conditions, microglia cells express
large amounts of iNOS, which catalyzes the production of NO. In these
conditions, NO becomes a toxic free radical exacerbating tissue inflammation
and induces cell apoptosis, oxidative stress, and neuronal impairment.[30,35] Furthermore, high TNF-α levels are critical in the pathogenesis
of inflammation and enhance the production of toxic substances, including
NO.[8] Then, the next step was to investigate
the effect of AE in the expression of iNOS and the NO release. iNOS
expression was measured in the cytosolic lysates of BV2 cells after
24 h of treatments. As Figure a shows, as expected, iNOS expression was not observed in
the cytosol of LPS-unstimulated cells. Nevertheless, when BV2 cells
were LPS-activated, iNOS expression was detected. Moreover, iNOS levels
were decreased, almost 40%, by the Streptomyces-derived
compound or CsA (p < 0.05). Hence, to check if
iNOS reduction affects the NO release, nitrite (a marker of NO production)
concentration was measured in cell supernatants. In the medium of
cells treated with LPS the NO concentration was 7.41 ± 0.31 μM.
Meanwhile, in the medium of the untreated cell it was 0.46 ±
0.03 μM (Figure b). As happens with iNOS expression, the NO release was significantly
decreased, 30%, by AE pretreatment (p < 0.001).
Also, CsA notably reduced the NO liberation (p <
0.001). Therefore, AE significantly reduced both iNOS expression and
NO release, suggesting its anti-inflammatory and neuroprotective potential.
In this sense, it has been demonstrated that silenced iNOS expression
has neuroprotective effects in an animal model of Parkinson’s
disease and microglial activation is reduced.[36]
Figure 4
Effect
of AE on iNOS expression and the generation of NO in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE 0.1 μM for
1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA was
used as a control of anti-inflammatory effects (1 μM). iNOS
expression was measured in cytosolic lysates by Western blot (a).
NO was measured by Griess reagent (b). Data are represented as a percentage,
being the result of the mean ± SEM of a minimum of N = 3 independent experiments performed in duplicate. The values are
shown as the difference between cells treated with LPS alone versus
cells treated with compounds in the presence of LPS by ANOVA statistical
analysis followed by post hoc Dunnet’s t-test:
*p < 0.05, **p < 0.01, ***p < 0.001, or cells treated with LPS versus control cells; ###p < 0.001. AE: anhydroexfoliamycin.
CsA: cyclosporine A. LPS: lipopolysaccharide.
Effect
of AE on iNOS expression and the generation of NO in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE 0.1 μM for
1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA was
used as a control of anti-inflammatory effects (1 μM). iNOS
expression was measured in cytosolic lysates by Western blot (a).
NO was measured by Griess reagent (b). Data are represented as a percentage,
being the result of the mean ± SEM of a minimum of N = 3 independent experiments performed in duplicate. The values are
shown as the difference between cells treated with LPS alone versus
cells treated with compounds in the presence of LPS by ANOVA statistical
analysis followed by post hoc Dunnet’s t-test:
*p < 0.05, **p < 0.01, ***p < 0.001, or cells treated with LPS versus control cells; ###p < 0.001. AE: anhydroexfoliamycin.
CsA: cyclosporine A. LPS: lipopolysaccharide.LPS acts as a ligand for TLR4 and activates the inflammatory cascade,
inducing downstream signal pathways such as NF-κB.[10] The transcription factor NF-κB regulates
multiple processes, namely, inflammation, apoptosis, immune response,
and cell survival, among others. Nevertheless, NF-κB activation
in glial cells causes the activation of M1 phenotypic microglia resulting
in neuroinflammation, participating in the pathogenesis of neurodegenerative
diseases.[11] The NF-κB activation
depends on its translocation from the cytosol to the nucleus. In normal
conditions, NF-κB is retained in the cytosol bound to the inhibitory
protein IκB. The inflammatory stimuli, in this case, LPS, promote
the phosphorylation and proteasomal degradation of IκB and result
in the nuclear translocation of NF-κB p65 subunit, producing
proinflammatory cytokines and mediators, including TNF-α and
IL-6.[9] Moreover, the levels of TNF-α
and IL-6 are increased in neurodegenerative diseases and microglia
injury, and their concentrations were also measured in the cellular
media of LPS-stimulated BV2.[37] Hence, as Figure a shows, in the medium
of unstimulated cells, IL-6 was barely detected. Nevertheless, high
IL-6 amounts were observed in LPS-stimulated BV2 cells medium (3533.66
± 158.28 pg/mL). IL-6 release by LPS-stimulated cells was significantly
inhibited, 30%, by the pretreatments with the Streptomyces derivative compound or CsA (p < 0.01). In the
case of TNF-α, Figure b, its release in activated microglia was also increased (1579.31
± 119.22 pg/mL) more than 3 times, compared with control cells
(p < 0.001). Furthermore, in the presence of AE,
TNF-α concentration was reduced (1036.82 ± 76.86 pg/mL)
in the medium, at the same level as CsA. Thus, AE reduces the release
of proinflammatory cytokines by activated microglia.
Figure 5
Effect of AE on the release
of IL-6 and TNF-α in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE at 0.1 μM
for 1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA
was used as a control of anti-inflammatory effects (1 μM). IL-6
(a) and TNF-α (b) levels were measured by ELISA. Data are represented
as a percentage, being the result of the mean ± SEM of a minimum
of N = 3 independent experiments performed in duplicate.
The values are shown as the difference between cells treated with
LPS alone versus cells treated with compounds in the presence of LPS
by ANOVA statistical analysis followed by post hoc Dunnet’s t-test: **p < 0.01, or cells treated
with LPS versus control cells; ###p <
0.001. AE: anhydroexfoliamycin. CsA: cyclosporine A. LPS: lipopolysaccharide.
Effect of AE on the release
of IL-6 and TNF-α in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE at 0.1 μM
for 1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA
was used as a control of anti-inflammatory effects (1 μM). IL-6
(a) and TNF-α (b) levels were measured by ELISA. Data are represented
as a percentage, being the result of the mean ± SEM of a minimum
of N = 3 independent experiments performed in duplicate.
The values are shown as the difference between cells treated with
LPS alone versus cells treated with compounds in the presence of LPS
by ANOVA statistical analysis followed by post hoc Dunnet’s t-test: **p < 0.01, or cells treated
with LPS versus control cells; ###p <
0.001. AE: anhydroexfoliamycin. CsA: cyclosporine A. LPS: lipopolysaccharide.The transcription factors NF-κB and Nrf2
in microglia are
modulators of their proinflammatory and antioxidant responses, respectively.[38] So, given the results above, the translocation
from cytosol to the nucleus of NF-κB and Nrf2 was assessed by
Western blot. Then NF-κB p65 and Nrf2 were measured in the cytosol
and nucleus and their translocation ratios were calculated. As Figure a shows, the NF-κB
p65 translocation was doubled when BV2 was activated with LPS (p < 0.001). The NF-κB p65 translocation was significantly
inhibited with the pretreatments with AE or CsA (p < 0.001). Thus, the inhibition of NF-κB could foster the
phenotypic shift of M1 to M2. Moreover, recent studies have shown
that the regulation of the microglial phenotype through NF-κB
downregulation has neuroprotective effects as inflammation is reduced.[39,40] Besides, the proinflammatory mediators NF-κB stimulated, such
as TNF-α and IL-6, cause blood–brain barriers (BBB) disruption,
allowing lymphocytes to enter the brain exacerbating CNS inflammatory
response.[37] Also, elevated levels of TNF-α
and IL-6 in the brain have been associated with neuronal damage and
neuroinflammation. Besides, TNF-α mediates the apoptosis of
neurons.[9] Thus, targeting both TNF-α
and IL-6 prevents not only CNS inflammation but also neuronal death.
From our results, it could be hypothesized that the inhibition of
TNF-α and IL-6 by AE could be related to the NF-κB blockage.
Therefore, these results suggest that mediating NF-κB translocation
by AE may reduce the expression of proinflammatory mediators and cytokines,
alleviating the activation of BV2.
Figure 6
Effect of AE on the expression of NF-κB
and Nrf2 in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE at 0.1 μM
for 1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA
was used as a control of anti-inflammatory effects (1 μM). The
NF-κB p65 subunit expression was measured in cytosolic and nucleus
lysates by Western blot and represented as nucleus/cytosol ratio (a).
Nrf2 expression was measured in cytosolic and nucleus lysates by Western
blot and represented as nucleus/cytosol ratio (b). Data are represented
as a percentage, being the result of the mean absorbance ± SEM
of a minimum of N = 3 independent experiments performed
in triplicate. The values are shown as the difference between cells
treated with LPS alone versus cells treated with compounds in the
presence of LPS by ANOVA statistical analysis followed by post hoc
Dunnet’s t-test: *p <
0.05, **p < 0.01, or cells treated with LPS versus
control cells; ###p < 0.001. AE: anhydroexfoliamycin.
CsA: cyclosporine A. LPS: lipopolysaccharide.
Effect of AE on the expression of NF-κB
and Nrf2 in LPS-stimulated
microglia BV2 cells. Cells were pretreated with AE at 0.1 μM
for 1 h and then were stimulated with LPS (500 ng/mL) for 24 h. CsA
was used as a control of anti-inflammatory effects (1 μM). The
NF-κB p65 subunit expression was measured in cytosolic and nucleus
lysates by Western blot and represented as nucleus/cytosol ratio (a).
Nrf2 expression was measured in cytosolic and nucleus lysates by Western
blot and represented as nucleus/cytosol ratio (b). Data are represented
as a percentage, being the result of the mean absorbance ± SEM
of a minimum of N = 3 independent experiments performed
in triplicate. The values are shown as the difference between cells
treated with LPS alone versus cells treated with compounds in the
presence of LPS by ANOVA statistical analysis followed by post hoc
Dunnet’s t-test: *p <
0.05, **p < 0.01, or cells treated with LPS versus
control cells; ###p < 0.001. AE: anhydroexfoliamycin.
CsA: cyclosporine A. LPS: lipopolysaccharide.When Nrf2 expression was measured, no significant differences were
detected between LPS-stimulated BV2 cells and controls (Figure b). However, the metabolite
AE significantly enhances the translocation of Nrf2 in activated microglial
cells (p < 0.01) to a larger extent than CsA control
(p < 0.05). Hence, the Streptomyces derivative inhibits NF-κB p65 translocation and meanwhile
promotes Nrf2 translocation. Nrf2 is a redox-sensitive transcription
factor, which activates antioxidant and cytoprotective genes and enzymes
upon oxidative conditions. Also, Nrf2 modulates microglia phenotype,
from the proinflammatory phenotype in favor of the anti-inflammatory.
In the present study, AE acted as an Nrf2 inductor and reduced ROS
levels in activated microglia. These results agree with previous studies;
the AE has shown interesting neuroprotective and antioxidant activities,
acting on mitochondria. ROS productions were reduced by this compound
in primary cortical neurons; moreover, it improved antioxidant enzyme
levels and the Nrf2 translocation.[19] However,
despite several antioxidant compounds that have been effective in
alleviating neurodegenerative disorders in in vitro experiments, in most in vivo studies they did not
show neuroprotective or anti-inflammatory effects.[41] This inefficacy in animal models is attributed to the instability
of compounds or due to the difficulty of the compounds reaching brain
cells, among others.[32] The beneficial effects
shown by AE in rodents against Alzheimer’s disease hallmarks
indicate that this compound crosses the BBB, predicting a possible
favorable in vivo role of this compound.[20]In addition to NF-κB pathway, MAPK
signaling pathway activation
is required for microglia-mediated CNS inflammation. Upon inflammatory
stimuli or stressors and proinflammatory mediators such as TNF-α,
among others, the MAPK signaling pathway is activated, including extracellular
signal-regulated kinase (ERK) 1/2, c-Jun N-terminal kinase (JNK),
and p38 pathway.[42] Between them, JNK plays
a key role in microglia activation and is responsible for tau phosphorylation
in Alzheimer’s disease.[18] Therefore,
the effect of AE over the JNK MAPK signaling pathway was also tested.
As shown in Figure , when BV2 cells were LPS-stimulated, the levels of phosphorylated
JNK were increased. When cells were pretreated with AE, the phosphorylation
of JNK was significantly suppressed, more than 20% (p < 0.001). In the case of CsA pretreatment, the JNK phosphorylation
was 15% reduced. In this sense, these results suggest that JNK is
an important molecular target of this compound. Moreover, JNK phosphorylation
inhibition prevents tau phosphorylation and synaptic dysfunction.
Furthermore, the inhibition of the JNK pathway helps to prevent the
inflammatory response induced by overactivated microglia.[43] Therefore, AE could be modulating the inflammatory
cascade by JNK inhibition. However, more studies in other MAPK pathways
(ERK 1/2 and p38) will be interesting.
Figure 7
Effect of AE on the expression
of JNK in LPS-stimulated microglia
BV2 cells. Cells were pretreated with AE at 0.1 μM for 1 h and
then were stimulated with LPS (500 ng/mL) for 24 h. CsA was used as
a control of anti-inflammatory effects (1 μM). The total-JNK
expression was measured in cytosolic and phosphorylated-JNK in nucleus
lysates by Western blot and represented as nucleus/cytosol ratio.
Data are represented as a percentage, being the result of the mean
absorbance ± SEM of a minimum of N = 3 independent
experiments performed in triplicate. The values are shown as the difference
between cells treated with LPS alone versus cells treated with compounds
in the presence of LPS by ANOVA statistical analysis followed by post
hoc Dunnet’s t-test: *p <
0.05, ***p < 0.001, or cells treated with LPS
versus control cells; ###p < 0.001.
AE: anhydroexfoliamycin. CsA: cyclosporine A. LPS: lipopolysaccharide.
Effect of AE on the expression
of JNK in LPS-stimulated microglia
BV2 cells. Cells were pretreated with AE at 0.1 μM for 1 h and
then were stimulated with LPS (500 ng/mL) for 24 h. CsA was used as
a control of anti-inflammatory effects (1 μM). The total-JNK
expression was measured in cytosolic and phosphorylated-JNK in nucleus
lysates by Western blot and represented as nucleus/cytosol ratio.
Data are represented as a percentage, being the result of the mean
absorbance ± SEM of a minimum of N = 3 independent
experiments performed in triplicate. The values are shown as the difference
between cells treated with LPS alone versus cells treated with compounds
in the presence of LPS by ANOVA statistical analysis followed by post
hoc Dunnet’s t-test: *p <
0.05, ***p < 0.001, or cells treated with LPS
versus control cells; ###p < 0.001.
AE: anhydroexfoliamycin. CsA: cyclosporine A. LPS: lipopolysaccharide.The release of proinflammatory factors such as
cytokines, NO, and
ROS by activated microglia is detrimental to neurons. For this reason,
a coculture system with BV2 microglia and SH-SY5Y neuronal cells was
used.[44] With this system, the effects of
toxicants released by microglia on neuronal cell viability can be
checked. Thus, the anti-inflammatory effects of AE over activated
microglia and how this affects neuronal viability were tested in the
coculture system. Neuronal cells were grown at the bottom of the 24-well
plate and microglial cells in inserts. Through the semipermeable membrane
of the insets, the microglia and neuron cells share the environment,
avoiding direct contact between them. First, the effect of AE or CsA
plus LPS over neuronal cell viability in the absence of BV2 was tested.
As Figure a shows,
neither compound alone nor in the presence of LPS affects the viability
of the SH-SY5Y cells. Then, the viability of SH-SY5Y in the presence
of activated BV2 cells was determined. For this purpose, BV2 cells
were placed in the insets of the coculture system and were pretreated
with AE or CsA before the stimulation with LPS. As Figure b shows, the cell viability
of neurons was 25% decreased (p < 0.001) when
BV2 cells were activated by LPS. Nevertheless, the pretreatment with Streptomyces derivative or CsA significantly protected SH-SY5Y
cells from the neurotoxic factors released by LPS-activated microglia,
restoring cell viability almost to control cell values (p < 0.05). Therefore, AE protects the neurons against the damage
caused by cytokines, NO, and ROS released by activated microglia.
Figure 8
Effect
of AE on SH-SY5Y survival microglia-neuronal coculture system.
SH-SY5Y cells were pretreated with AE (0.1 μM) for 1 h and then
were stimulated with LPS (500 ng/mL) for 24 h (a). SH-SY5Y cells were
cultured with LPS-stimulated microglia BV2 cells with pretreatment
of AE (0.1 μM) for 24 h (b). CsA was used as a control of anti-inflammatory
effects (1 μM). MTT assay was performed to determine SH-SY5Y
cell viability. Data are represented as a percentage, being the result
of the mean absorbance ± SEM of a minimum of N = 3 independent experiments performed in triplicate. The values
are shown as the difference between cells treated with LPS alone versus
cells treated with compounds in the presence of LPS by ANOVA statistical
analysis followed by post hoc Dunnet’s t-test:
*p < 0.05, or cells treated with LPS versus control
cells; ###p < 0.001. AE: anhydroexfoliamycin.
CsA: cyclosporine A. LPS: lipopolysaccharide.
Effect
of AE on SH-SY5Y survival microglia-neuronal coculture system.
SH-SY5Y cells were pretreated with AE (0.1 μM) for 1 h and then
were stimulated with LPS (500 ng/mL) for 24 h (a). SH-SY5Y cells were
cultured with LPS-stimulated microglia BV2 cells with pretreatment
of AE (0.1 μM) for 24 h (b). CsA was used as a control of anti-inflammatory
effects (1 μM). MTT assay was performed to determine SH-SY5Y
cell viability. Data are represented as a percentage, being the result
of the mean absorbance ± SEM of a minimum of N = 3 independent experiments performed in triplicate. The values
are shown as the difference between cells treated with LPS alone versus
cells treated with compounds in the presence of LPS by ANOVA statistical
analysis followed by post hoc Dunnet’s t-test:
*p < 0.05, or cells treated with LPS versus control
cells; ###p < 0.001. AE: anhydroexfoliamycin.
CsA: cyclosporine A. LPS: lipopolysaccharide.When microglia are activated, in addition to releasing proinflammatory
mediators, their morphology is also altered.[45,46] So it was checked if LPS causes morphological and/or cytoskeletal
variations in BV2 cells. For this purpose, BV2 cells were grown in
coverslips, followed by fixation and labeling with Oregon Green 514
phalloidin (green), a marker for F-actin, and with Texas Red DNase
I (red), a marker for G-actin. As Figure a shows, unstimulated microglia cells were
uniform in size and form with a round cytoplasm. When cells are treated
with LPS, the size and cell form vary. The cytoplasm space was expanded
with the formation of filopodia. Then, whether the Streptomyces derivative compound affects the morphological changes produced by
LPS was checked. In the presence of EA, the cytoplasmic size and shape
of the cells revert to those of the unstimulated cells, at the same
level as CsA. The area of BV2 cells in the above conditions was also
calculated. The area of LPS-stimulated cells was increased by almost
50% when compared with untreated cells (Figure b, p < 0.01). Moreover,
with AE pretreatment the cell area is 30% decreased and 20% in the
case of CsA pretreatments.
Figure 9
Effect of AE on BV2 cells actin cytoskeleton
and morphology. Cells
were pretreated with AE at 0.1 μM for 1 h and then were stimulated
with LPS (500 ng/mL) for 24 h. CsA was used as a control of anti-inflammatory
effects (1 μM). Confocal imaging of F-actin (green) and G-actin
(red) double-staining of BV2 microglia cells (a). Images are representative
of three independent experiments. Scale bar = 50 μM. BV2 cells
area (b). Data are represented as a percentage, being the result of
the mean ± SEM of a minimum of N = 3 independent
experiments performed in duplicate. The values are shown as the difference
between cells treated with LPS alone versus cells treated with compounds
in the presence of LPS by ANOVA statistical analysis followed by post
hoc Dunnet’s t-test: *p <
0.05, or cells treated with LPS versus control cells; ##p < 0.01. AE: anhydroexfoliamycin. CsA: cyclosporine
A. LPS: lipopolysaccharide.
Effect of AE on BV2 cells actin cytoskeleton
and morphology. Cells
were pretreated with AE at 0.1 μM for 1 h and then were stimulated
with LPS (500 ng/mL) for 24 h. CsA was used as a control of anti-inflammatory
effects (1 μM). Confocal imaging of F-actin (green) and G-actin
(red) double-staining of BV2 microglia cells (a). Images are representative
of three independent experiments. Scale bar = 50 μM. BV2 cells
area (b). Data are represented as a percentage, being the result of
the mean ± SEM of a minimum of N = 3 independent
experiments performed in duplicate. The values are shown as the difference
between cells treated with LPS alone versus cells treated with compounds
in the presence of LPS by ANOVA statistical analysis followed by post
hoc Dunnet’s t-test: *p <
0.05, or cells treated with LPS versus control cells; ##p < 0.01. AE: anhydroexfoliamycin. CsA: cyclosporine
A. LPS: lipopolysaccharide.As above-described, after stimulation, microglia can switch its
phenotype between proinflammatory M1 and immunosuppressive M2.[3] In this sense, the present results suggest that
the natural product AE could change the polarization of the microglia
to the immunosuppressive phenotype since the natural compound promotes
the nuclear translocation of Nrf2 rather than NF-κB. In addition,
morphological changes and an increment in the cell area were observed
in LPS-stimulated BV2 cells, which is a sign of M1 polarization.[46,47] The ability of AE to minimize these morphological changes, in addition
to the anti-inflammatory effects shown in this study, suggests that
this compound reverses the phenotype M1 toward the anti-inflammatory
M2. These data are consistent with current research, demonstrating
that blueberry extracts shift the phenotype of LPS-stimulated BV2
cells for the immunosuppressive M2.[46] Moreover,
recent studies have outlined that the induction of M2 cell activation
is a promising target in the context of neurodegenerative diseases.[39] Moreover, from our results in the microglia
and neuron coculture, AE is not neurotoxic. Inhibiting proinflammatory
mediators released by activated microglia, AE can prevent neuronal
cell death caused by microglia cell-driven neuroinflammation. Some Streptomyces-derived compounds have shown similar anti-inflammatory
effects, as in the case of violacin A.[48] These data confirm the anti-inflammatory functions of AE.Finally, all experiments were compared with the well-known immunosuppressive
CsA. It is widely used to reduce transplant rejection. Moreover, CsA
has shown neuroprotective activities by preserving normal mitochondrial
function.[49] Nevertheless, its use in neurodegeneration
is limited by its side effects and its high hepatic and nephrotoxicity.[50] The present study, despite using AE at a lower
dose than CsA, has shown similar or stronger anti-inflammatory effects
compared with CsA.
Conclusions
In the
present study, we showed that AE inhibits the inflammatory
response in activated microglia. Moreover, it is the first evidence
that AE inhibits LPS-induced NF-κB and JNK pathways activation
and their subsequent inflammatory cascade, including the release of
proinflammatory and neurotoxic mediators that are detrimental to neurons
and can lead to neuron death. These data, together with the promising
results shown in primary neurons and in in vitro and in vivo models of Alzheimer’s disease, suggest that
AE acts on several neuroinflammation targets.[19,20] Considering that neuroinflammation and degenerative diseases are
multifactorial, this multitarget compound is a potential candidate
in these pathologies’ treatment since it acted in the main
hallmarks of the diseases. However, further studies would be necessary
to better understand its action mechanism.
Materials and Methods
Chemicals
and Solutions
The natural
compound AE (Figure ) was kindly donated by Dr. Marcel Jaspars from the Marine Biodiscovery
Centre (Department of Chemistry, University of Aberdeen, Scotland,
U.K.). This compound was isolated as described before.[19,20] The stock solution of the compound was done in dimethylsulfoxide
(DMSO).Microglia BV2 cell line was obtained from InterLab Cell
Line Collection (ICLC), number ATL03001 (Genova, Italy). The human
neuroblastoma SH-SY5Y cell line was purchased from American Type Culture
Collection (ATCC), number CRL2266. Dulbecco’s modified Eagle
medium: Mix F-12 nutrient (DMEN/F-12), Roswell Park Memorial Institute
Medium (RPMI), penicillin–streptomycin (10000 U/mL), trypsin/EDTA
(0.05%), Glutamax, SuperSignal West Pico, SuperSignal West Femto,
7′,2′-dichlorofluorescein diacetate (DCFH-DA), tetramethylrhodamine
methyl ester (TMRM), Griess reagent kit for nitrite quantitation,
and anti-actin monoclonal antibody (catalog no. ACTN05 (C4), lot no.
SK2474691D) were obtained from Thermo Fisher Scientific (Madrid, Spain).
Magnetic bead panel Milliplex map kit (no. MHSTCMAG-70k), Millicell
hanging cell culture insert (0.4 μm), polyvinylidene difluoride
(PVDF) membrane, anti-NF-E2-related factor 2 antibody (catalog no.
ABE413, lot no. 3035180), and anti-NF-κB p65 antibody (catalog
no. ABE347, lot no. 2897243) were purchased from Merk (Madrid, Spain).
Anti-lamin B1 antibody (catalog no. ab16048, lot no. GR3188002-1)
and anti-iNOS antibody (catalog no. ab178945, lot no. GR324713-8)
were bought in Abcam (Madrid, Spain). Anti-p-JNK/SAPK (pT183/pY185)
(catalog no. 612540) and anti-JNK/SAPK1 (catalog no. 610627) were
purchased from BD Biosciences. Polyacrylamide gels and molecular weight
marker Precision Plus Protein Standards Kaleidoscope were obtained
from Bio-Rad (Barcelona, Spain). Protease inhibitor Complete tablets
and phosphatase inhibitor cocktail tablets were from Roche (Spain).
3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT),
sodium dodecyl sulfate (SDS), lipopolysaccharide, saponin from quillaja
bark, bovine serum albumin (BSA), and the rest of the reagents used
were purchased from Sigma-Aldrich (Madrid, Spain).
Cell Culture
Microglia BV2 cells
were cultured in Roswell Park Memorial Institute Medium (RPMI) plus
10% fetal bovine serum (FBS), penicillin (100 U/mL), and 100 μg/mL
streptomycin at 37 °C in a humidified atmosphere of 5% CO2 and 95% air. Cells were dissociated twice a week using 0.05%
trypsin/EDTA (1×).Neuroblastoma SH-SY5Y cells were maintained
in Dulbecco’s modified Eagle Mmedium: Nutrient Mix F-12 (DMEN/F-12)
supplemented with 10% FBS, 1% Glutamax, penicillin (100 U/mL), and
100 μg/mL streptomycin at 37 °C in a humidified atmosphere
of 5% CO2 and 95% air. Cells were dissociated weekly using
0.05% trypsin/EDTA (1×).
Cell
Viability Assay
Cell viability
was assessed using the MTT assay, as previously described.[51] Briefly, microglia BV2 cells were seeded in
96-well plates (at a density of 4 × 104 cells per
well) and exposed to different compound concentration (0.001, 0.01,
0.1, 1, and 10 μM) for 24 h or were pretreated with AE (0.001,
0.01, 0.1, 1, and 10 μM) 1 h before the stimulation with LPS
(500 ng/mL) for 24 h. After incubation, cells were rinsed and incubated
with MTT (500 μg/mL) diluted in a saline buffer for 1 h at 37
°C. Then, MTT excess was washed, cells were disaggregated with
5% SDS, and the absorbance of colored formazan salt was obtaining
using a spectrophotometer plate reader (595 nm). Saponin was used
as a cellular death control, and its absorbance was substrate from
the other data.
Measurement of Intracellular
ROS Production
Intracellular ROS levels were measured using
DCFH-DA, as previously
described.[52] In brief, BV2 cells were treated
with AE (0.1 μM) or CsA (1 μM) in the presence or absence
of LPS (500 ng/mL). After 24 h, cells were rinsed twice with saline
buffer and incubated 1 h at 37 °C with 20 μM DCFH-DA. During
this time, DCFH-DA enters the cell and is deacetylated by cellular
esterases, which is oxidized by ROS in 7′,2′-dichlorofluorescein
(DCF). DCF is fluorescent and is detected on a spectrophotometer plate
reader (495 nm excitation and 527 nm emission).
NO Release Determination
The release
of NO to the culture medium by BV2 cells was established by measuring
nitrite formed by the oxidation of NO, using the Griess reagent kit,
according to the manufacturer’s instructions. Briefly, microglia
cells were seeded in a 12-well plate (1 × 106 cells
per well) and preincubated with AE (0.1 μM) or CsA (1 μM)
1 h after the stimulation with LPS (500 ng/mL) for 24 h. Then, in
a 96-well plate were mixed 150 μL of cells supernatant, 130
μL of deionized water, and 20 μL of Griess reagent, and
the mixture was incubated for 30 min at room temperature. The absorbance
values were measured on a spectrophotometer plate reader (548 nm).
Western Blot Analysis
The expression
of Nrf2, NF-κβ, p-JNK, JNK, and the iNOS was assessed
by Western blot as previously described.[53,54] In brief, BV2 cells were grown in a 12-well plate and treated as
experiments before. Then, cells were centrifuged (1000 rpm and 4 °C
for 5 min), rinsed with cold saline buffer and were suspended in 100
μL of ice-cold hypotonic lysis buffer (20 mM Tris-HCl, pH 7.4,
10 mM NaCl, and 3 mM MgCl2 containing complete phosphatase/protease
inhibitors cocktail). After 15 min of incubation on ice, cells were
centrifuged (10 min at 4 °C and 3000 rpm). The supernatant was
collected as a cytosolic fraction, and protein concentration was determined
by Direct Detect (Millipore). The pellet was suspended in 30 μL
of ice-cold nuclear extraction buffer (100 mM Tris, pH 7.4, 2 mM Na3VO4, 100 mM NaCl, 1% Triton X-100, 1 mM EDTA, 10%
glycerol, 1 mM EGTA, 0.1% SDS, 1 mM NaF, 0.5% deoxycholate sodium,
and 20 mM Na4P2O7, 1 mM PMSF, and
10× protease inhibitor cocktail) for 30 min and centrifuged (30
min at 14.000g and 4 °C). Supernatants were
collected as protein nuclear fractions, and their protein concentration
was measured using Bradford assay. An amount of 10 μg of nuclear
fractions or 15 μg of cytosolic fractions was used for electrophoresis
and was resolved on polyacrylamide gels and transferred onto PVDF
membrane. Precision Plus Protein Standards Kaleidoscope molecular
weight marker was used to determine protein size. Membranes were blocked
with 0.5% BSA, and antibody incubation was performed using SNAP i.d.
protein detection system. The immunoreactive bands were detected using
the SuperSignal West Pico or SuperSignal West Femto and the Diversity
GeneSnap software (Syngene). Nrf2 was detected with anti-NF-E2-related
factor 2 antibody (1:1000), p-JNK was detected with p-JNK (1:500),
JNK with anti JNK (1:1000), iNOS was assessed with anti-iNOS (1:2000)
and the NF-κβ with anti-NF-κβ p65 (1:1000).
The signal was normalized by that of β-actin (1:2000) for cytosolic
samples and by that of laminin B1 (1:1000) for nuclear samples.
Measurement of IL-6 and TNF-α Levels
The amount of IL-6 and TNF-α released by BV2 cells was measured
on culture medium supernatants using a magnetic bead-based multiplex
immunoassay (Milliplex Map Kit) following the manufacturer's
instructions
and as described before.[31] In brief, BV2
cells were seeded in a 12-well plate (1 × 106 cells
per well) and treated as described above. The culture medium supernatant
was collected and kept at −80 °C until enzyme-linked immunosorbent
assay (ELISA) was performed. The median relative fluorescence units
were measured using the Luminex 200 with xPONENT software. The samples
were analyzed in duplicate, and the concentration was calculated using
a standard curve. The minimum detectable concentration is 0.54 pg/mL
for IL-6 and 0.41 pg/mL for TNF-α. Culture medium levels below
the lower limit of determination were considered as 0 pg/mL for statistical
analysis. There was no or negligible cross-reactivity between the
antibodies and any other analyte. The intra-assay coefficient of variation
of the ELISA kits was <10%. The interassay coefficient of variation
of the ELISA kit was <10%.
Microglia
and Neuron Coculture System
Neuroblastoma SH-SY5Y cells were
grown in the bottom of a 24-well
plate, while BV2 microglia cells were grown in culture inserts (pore
size 0.4 μm). Through a semipermeable membrane of the insets,
the microglia can communicate with the neurons, avoiding direct contact
between the two cell lines.[55] Inserts containing
microglia were treated with AE (0.1 μM) or CsA (1 μM)
1 h before LPS treatment (500 ng/mL) for 24 h. Then cellular inserts
were removed and MTT assay was performed over SH-SY5Y cells, as described
above, to check the cytotoxic effects of activated microglia mediators
over neurons.
F- and G-Actin Cytoskeleton
Staining and Confocal
Microscope Visualization
F- and G-actin levels were analyzed
using a confocal microscopy for visualizing morphology and the actin
cytoskeleton. After incubation with compounds, for actin labeling,
BV2 cells were washed with PBS and fixed with 4% paraformaldehyde.
Afterward, cells were permeabilized with PBS-0.1% Triton X-100-2.5%
BSA for 5 min and then, for F-actin labeling were incubated with 0.165
μM Oregon Green 514 phalloidin and for G-actin labeling with
0.3 μM Texas Red DNase I for 20 min, followed by PBS washes.
Coverslips were mounted in glycerol–PBS and sealed with nail
polish and stored at 4 °C.Images were acquired by using
a 40× oil immersion objective in a Nikon Eclipse TE2000-E inverted
microscope attached to the C1 laser confocal system (EZC1 V.2.20 software;
Nikon Instruments Europe B.V., Netherlands). To excite Oregon Green
514 phalloidin a 488 nm argon laser was used and a 561 nm helium–neon
laser for exciting Texas Red DNase I. All laser parameters were adjusted
with control cells and remain unchanged for the treated BV2 cells
subsequent analysis. Fluorescent images were acquired at a resolution
of 512 × 512 pixels separately for each fluorophore and then
mixed to avoid interfaces. No interferences of Texas Red in green
channel and Oregon Green in red channel were observed.
Statistical Analysis
Results were
expressed as mean ± SEM of a minimum of three independent experiments
performed by duplicate or triplicate. Comparisons were analyzed using
ANOVA statistical analysis followed by post hoc Dunnet’s t-test. P values <0.05 were considered statistically
significant.